Excuses, excuses

“So you’ve been slacking off a little,” our friend, T, said as soon as he arrived from Colorado for dinner and a short stint in the spare room. “What’s going on?”

T is right. The once weekly blog posts became twice monthly and then, more recently, monthly, and now they are more infrequent than that. A quick recce confirms that my last post was at the end of August and we are now approaching the end of September.

So what is going on?

First up in the line of excuses is visits from the likes of T, the frequency of which has escalated in the run up to our leaving New York in October. The steady stream of visitors started with the son and nephew in late August, and ended with daughter number one and the great Nanny J, who looked after all our kids when they were young and came to New York as part of her eightieth birthday celebrations. Touring New York with close friends and family in a cocktail induced haze is enormous fun, but hardly conducive to blogging productivity.

Excuse number two is that I seem to have spent much of the last month entangled with the US medical establishment. Please don’t be alarmed. There’s no bad news at the end of this paragraph. But there is a story about the peculiarities, both good and bad, of US style healthcare.

It all started back in May when I had some routine blood tests and a mammogram. These were all conducted as part of the health check mandated by our insurance provider. (Quite how I made it to late May before having them is something of a mystery.) Anyhoo, up I rocked for my tests, smugly expecting to be awarded an A* for all of them. Trips to the UK and Wyoming intervened, meaning that I didn’t follow up on the test results until late August. Then the fun began.

Not all A*s after all. Much of the blood test report was incomprehensible to me (Leukocytes, anyone? Squamous epithelial cells? Methyllemonic acid? Me neither.) But a follow up discussion with the doctor confirmed that my cholesterol was a smidge out of whack and my blood glucose levels a trifle high, and that I was deficient in a couple of vitamins. And my mammogram looked “odd”.

The vitamin issue was easy to fix. And Pink Robe prevented me from becoming overly concerned about the cholesterol readings. She sent me some pretty convincing evidence that worrying about LDL is so very last year; it’s the Triglyceride/HDL ratio that’s the key, and mine’s in pretty good shape.

But the rest of the abnormal results would require looking into, and that meant being sent for a follow up mammogram, a couple of CT scans, a cystoscopy, a stress test and consultations with no fewer than four different specialists. And that’s where I’ve been for much of September. I kid you not.

Let’s talk mammogram’s first. Every woman who’s ever had one knows how ghastly they are. For any male blog reader who might be unversed in this particular method of torture, a mammogram involves compressing the most sensitive part of your body inside a machine that’s akin to a giant toastie maker, whereupon the technician says, hold your breath! (You can’t breathe for the pain anyway), and then, “stay there a minute until I see if I’ve got everything”. (You couldn’t move if you wanted to, for fear of ripping your breast off) You then wait in an attractive paper gown while they check the images, often to be told that the technician would like to take a closer look from one particular angle, at which point you are forced to spend another excruciating few minutes trapped inside the toastie maker.

So. One mammogram every eighteen months is bad enough. To be asked to repeat it within weeks is enough to make you jelly kneed with dread.

These sorts of interventions are not only uncomfortable; they’re also a huge time sink. By my estimation, any thirty-minute consultation with a US specialist requires you to set aside an additional six to eight hours to deal with the attendant bureaucracy, including the before and after communications with the insurance company, the mountains of paperwork, the three assistants whom you must see before getting access to the specialist, and any pre-intervention assessment procedures deemed necessary. The specialists, once you get to see them, are invariably top notch, but my goodness, what a palaver.

To give you an example, before one of my exploratory procedures (which, admittedly, would involve a very brief period under general anaesthetic), I was required to spend three hours in a pre-procedure assessment exam that involved in depth questioning about my lifestyle and every illness, minor or major, that I or anyone in my family had ever had, extensive blood tests, blood pressure monitoring, an ECG and an ultrasound of my heart. By contrast, a friend who was to have a much lengthier and more complicated operation in Canada recalls having had her heart rate and blood pressure taken and… that’s it.

Another example. L1 went for a routine eye test because he needed a new supply of contact lenses. The visit – which, in the UK, would have taken fifteen minutes and cost forty quid – involved seeing three different people and spending an hour having weird liquids squirted in his eyes and cost eight hundred dollars. Eight hundred dollars! “But the opthalmologist was excellent and gave me some very good advice,” he said afterwards, still unable to see me clearly because of the lingering effects of the weird liquids.

The US system is most definitely belt and braces, as in, I think it’s probably nothing, but let’s send you for a CT scan/cystoscopy/biopsy anyway, and if we need to intervene, lets test the Hell out of you first. This seems be driven by two things: money and litigation. There’s always money to be made by referring someone onwards and upwards through the system, so why not make it? And there’s always money to be lost if someone chooses to sue you because you missed something, so why would you risk it?

No whining on the yacht, right? (C, that’s for you.) A lot of people in America would give their eye teeth and right elbow to have health insurance good enough to allow for this kind of over-zealous, over-engineered care. While I am racing all over Manhattan having every exploratory procedure known to medicine, many Americans can’t even afford to get an ear infection checked out. “Don’t even talk to me about it!” exclaimed T, flinging up his hands in anger and almost sending his glass of cabernet flying. But we talked about it anyway. T has experience of healthcare in the UK, Canada and the US, and is particularly enthusiastic about the publicly funded system in Alberta, which works, according to him, like a dream, for a great deal less money per capita than the US system and without hampering labour mobility, tying people to jobs they dislike or are no good at simply because they’re terrified of losing their insurance coverage.

These big picture deficiencies aside, I guess your point of view on the efficacy of the US system will depend on how good your particular insurance cover is, and whether or not all the referrals and interventions uncover something nasty that can therefore be dealt with early. No one’s going to resent a just-in-case CT scan or a second mammogram that saves their life.

And occasionally you find yourself dealing with a truly slick and impressive operation. Such was the case last Monday when I went to MEETH – the Manhattan Eye Ear and Throat Hospital – for a procedure that, ironically, had absolutely nothing to do with eyes, ears or throat. The hospital (which, conveniently, was all of a block from our apartment) has near seamless systems and appears to be staffed exclusively by charming and uber-competent professionals. (I was particularly taken by my anaesthetist – or anaesthesiologist, as they say here – and would have done just about anything she asked me to.) I met a lot of those professionals – I think there were no less than ten in the operating theatre when I strolled in for a routine procedure that was to last all of fifteen minutes. I felt in very safe hands indeed.

L1’s experience hasn’t been quite so smooth. There was that business with the eye watering – in every sense – ophthalmology consultation. In addition, after three attempts to have an MRI on his knee (remember the knee that kept him from line-dancing in Wyoming?), all of them foiled by paperwork mishaps or inefficient communications between primary care physician, specialist and insurance company, he’s given up on the system and decided to wait until he gets back to the UK. His knee has all but healed anyway, of its own accord.

But enough about healthcare and how it’s kept me from blogging. There’s a third excuse, and it’s this. Time is closing in on us. We have just a month left here in New York. (L1 has even less than this, as business requires him to be in Europe by early October). And as time runs out, I think we’ve become less interested in exploring new things (and writing about them), and more keen to savour the things we already know and love. We’re going to miss an awful lot about this city. I could list them all here and now, but I won’t. I’m going to save that for the next (and final) blog, just so T can’t accuse me of slacking.

Until then

P.S. I can’t sign off without saying Bravo to Dr Christine Blasey Ford for her brave and entirely credible testimony in the senate hearing designed to determine whether Judge Kavanaugh is of sufficiently upstanding character to be given a life time appointment to the US Supreme Court. If you watched any of the proceedings, and witnessed Judge Kavenaugh’s petulant outbursts when questioned about his having frequently been drunk to the point of “ralphing” and falling off buses, you’ve probably decided, like a couple of people who emailed me, that regardless of whether or not he assaulted Dr Ford, he is probably not of the ideal temperament to sit on the highest court in the land.

Thank God for the persuasiveness of senators like Senator Whitehouse and Senator Durbin who persisted in making the case for an FBI investigation, and for the fearless persistence of those women outside Jeff Flake’s lift who managed to make that investigation happen.